title: Association between maternal body mass index during pregnancy, short-term morbidity, and increased health service costs: a population-based study.
abstract: OBJECTIVE
  To investigate the impact of maternal body mass index (BMI, kg/m(2)) on clinical complications, inpatient admissions, and additional short-term costs to the National Health Service (NHS) in Scotland.
  
  
  METHODS
  Retrospective cohort study using an unselected population database.
  
  
  METHODS
  Obstetric units in Scotland, 2003-2010.
  
  
  METHODS
  A total of 124,280 singleton deliveries in 109,592 women with a maternal BMI recorded prior to 16 weeks of gestation.
  
  
  METHODS
  Population-based retrospective cohort study of singleton deliveries, with multivariable analysis used to assess short-term morbidity and health service costs.
  
  
  METHODS
  Maternal and offspring outcomes, number and duration of hospital admissions, and healthcare costs.
  
  
  RESULTS
  Using multivariable analysis, in comparison with women of normal weight, women who were overweight, obese, or severely obese had an increased risk of essential hypertension [1.87 (1.18-2.96), 11.90 (7.18-19.72), and 36.10 (18.33-71.10)], pregnancy-induced hypertension [1.76 (1.60-1.95), 2.98 (2.65-3.36), and 4.48 (3.57-5.63)], gestational diabetes [3.39 (2.30-4.99), 11.90 (7.54-18.79), and 67.40 (37.84-120.03)], emergency caesarean section [1.94 (1.71-2.21), 3.40 (2.91-3.96), and 14.34 (9.38-21.94)], and elective caesarean section [2.06 (1.84-2.30), 4.61 (4.06-5.24), and 17.92 (13.20-24.34)]. Compared with women of normal weight, women who were underweight, overweight, obese, or severely obese were associated with an 8, 16, 45, and 88% increase in the number of admissions, respectively, and women who were overweight, obese, or severely obese were associated with a 4, 9, and 12% increase in the duration of stay (all P < 0.001). The additional maternity costs [mean (95% CI), adjusted analyses] for women who were underweight, overweight, obese, or severely obese were £102.27 (£48.49-156.06), £59.89 (£41.61-78.17), £202.46 (£178.61-226.31), and £350.75 (£284.82-416.69), respectively.
  
  
  CONCLUSIONS
  Maternal BMI influences maternal and neonatal morbidity, the number and duration of maternal and neonatal admissions, and health service costs.
authors.affiliation: MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK.
authors.forename: F C
authors.initials: FC
authors.lastname: Denison
authors.forename: P
authors.initials: P
authors.lastname: Norwood
authors.forename: S
authors.initials: S
authors.lastname: Bhattacharya
authors.forename: A
authors.initials: A
authors.lastname: Duffy
authors.forename: T
authors.initials: T
authors.lastname: Mahmood
authors.forename: C
authors.initials: C
authors.lastname: Morris
authors.forename: E A
authors.initials: EA
authors.lastname: Raja
authors.forename: J E
authors.initials: JE
authors.lastname: Norman
authors.forename: A J
authors.initials: AJ
authors.lastname: Lee
authors.forename: G
authors.initials: G
authors.lastname: Scotland
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002585:Cesarean Section / Q000191:economics / Q000706:statistics & numerical data; D015331:Cohort Studies; D016640:Diabetes, Gestational / Q000191:economics / Q000453:epidemiology; D005260:Female; D017048:Health Care Costs; D006801:Humans; D006973:Hypertension / Q000191:economics / Q000453:epidemiology; D046110:Hypertension, Pregnancy-Induced / Q000191:economics / Q000453:epidemiology; D056865:Ideal Body Weight; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008427:Maternal Health Services / Q000191:economics*; D015999:Multivariate Analysis; D009765:Obesity / Q000191:economics / Q000453:epidemiology*; D050177:Overweight / Q000191:economics / Q000453:epidemiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000191:economics / Q000453:epidemiology*; D012189:Retrospective Studies; D012606:Scotland; D013222:State Medicine / Q000191:economics*; D013851:Thinness / Q000191:economics / Q000453:epidemiology*; D055815:Young Adult
keywords: Economics; healthcare costs; medical complications; obesity; pregnancy